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KMID : 0648320100160010031
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Journal of The Korean Society of Hypertension
2010 Volume.16 No. 1 p.31 ~ p.42
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The Effects of Combination Therapy of Felodipine and Ramipril on Plaque Regression and Plaque Compositional Changes in Patients with Hypertension and Angina with Mild to Moderate Degree of Coronary Stenosis
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Hong Young-Joon
Jeong Myung-Ho
Choi Yun-Ha
Ma Eun-Hae
Ko Jum-Suk
Lee Min-Goo
Park Keun-Ho
Sim Doo-Sun
Yoon Nam-Sik
Yoon Hyun-Ju
Kim Kye-Hun
Park Hyung-Wook
Kim Ju-Han
Ahn Young-Keun
Cho Jeong-Gwan
Park Jong-Chun
Kang Jung-Chaee
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Abstract
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Background : Calcium channel blockers (CCB) and angiotensin converting enzyme (ACE) inhibitors can block the development of atherosclerosis. Fixed-dose combinations of a CCB, felodipine, and an ACE inhibitor, ramipril, are more effective at controlling hypertension than monotherapy. We used serial virtual histology and intravascular ultrasound (VHIVUS) to assess the efficacy of combined felodipine + ramipril therapy on regression and compositional changes of plaque in patients with hypertension and angina with a mild to moderate degree of coronary stenosis. Comparisons were made to monotherapies.
Methods : This study was a prospective, comparative study using (1) felodipine 5 mg/ramipril 5 mg vs. (2)
felodipine 10 mg and ramipril 10 mg. A total of 68 lesions in 68 patients were analyzed and the three drug groups [felodipine group (n=25) vs. ramipril group (n=21) vs. felodipine/ramipril group (n=22) compared. VH-IVUS was done during baseline coronary angiography and repeated after 9-month of treatment.
Results : Nine months after the baseline IVUS examination, systolic and diastolic blood pressures decreased significantly in all three groups. There was no significant difference in changes in percent atheroma volume from baseline to follow-up comparing the three groups (pre- and post- scores for the felodipine, ramipril, and combination groups were, respectively, 49 6 to 48 6%, 47 5 to 46 5%, and 51 5 to 51 5%, p=0.908). There was no significant difference in change scores for plaque components from baseline to follow-up comparing the three groups. Change scores for the felodipine, ramipril, and combination groups, were, respectively, +2.5 9.2% vs. +1.3 11.6%, and 2.6 9.7% (p=0.224). Fibro-fatty change scores were -4.9 10.8%, -4.6 10.1% and -2.1 4.9%, (p=0.518). Calcium density change scores were +1.6 6.0%, +1.2 7.3% and +2.1 4.2%, (p=0.884). Necrotic core change scores were: +0.6 9.2%, +2.1 10.4% and +2.5 9.2%, (p=0.789).
Conclusion : Combination therapy with felodipine and ramipril has no advantage over monotherapy for treating plaque regression and plaque compositional changes in patients with hypertension and angina with a mild to moderate degree of coronary stenosis.
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KEYWORD
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Coronary Disease, Hypertension, Atherosclerosis, Intravascular Ultrasound
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